I know we are "just students" but sometimes you just need to go with your gut.

[~Mi Vida Loca~RN, ASN, RN]

and can easily be dismissed sometimes when we have concerns, but I just wanted to say, ALWAYS STICK TO YOUR GUT AND ADVOCATE FOR YOUR PATIENT.

I am doing my maternity OB rotation this week. Now I am not new to this subject, I worked in childcare for 5 years, I have 4 kids, I have been in the delivery for many friends and even the second half of 2 C-Sections. (baby is born and dad and everyone leaves and mom is left alone full of emotions so my G/F asked me to go in with her) so I got to see that part and her last one I got to watch the tubal ligation as well. I am really good with labor, and have been told by friends I was an awesome support person, more so then other people that had in the room.

So anyway, it's just not an area "new" to me. I know babies. Sometimes I think it's forgotten that we may be new students but might not be new to life. I know that nursing is different but people skills and some other things aren't only privy to nursing.

So anyway, I was in womans care the past 2 nights. Tonight I took on a patient that just seemed to be really ambivalent to baby. Baby was term and was really low birth weight. 5lbs 4 oz Mom admited to smoking "3" cigs a day and nothing more. The situation was very odd, and I would bet anything that baby was meant to be a "solution" to a troubled relationship. I got this from observing through out the day and I won't go into all of it right now because it's almost 2 and I need to get to bed soon. It's always hard for me to unwind after shift.

So from the get go I notice that baby's moro reflex is really hyperactive. The nurse tells me, Oh it's just how newborns are. Hmmmmm no this was a little abnormal. I know how newborns are and this baby is extremely jittery and the reflex wasn't quick, he would have it and jitter for a while. Baby was tachypnea ( I know I just spelled that wrong, or it doesn't look right), baby also had bradycardia. I listened to this babies heart for a long time, he kept jittering so much that it was hard to get a good HR. Every time he would jitter his HR would elevate and he was jittering more then normal so I got him still enough to listen real good for a few minutes (which was hard for him). I took his HR 2x for a full minute apical. Besides my first baby HR I have always came up within 2 beats of whoever checks after me. Our instructor taught us a trick since babies HR are so fast and since then its been pretty easy. Anyway, I did his HR twice and it was 92 one and 93 second time. So I tell the nurse. She takes it and it is when he is jittering a lot and she gets 112. I told her that it was speeding up a bit with during those periods but when he was calm it was lower. I mean even 112 is on the low end for a newborn (was born this morning). His RR was between 70 and 79 all day. He was not eating which I know can be normal but he was constantly sucking on his hands. He was getting tons of hiccups as well. Those 2 things wouldn't have red flagged me right away because that is more inline with babies and a new born but putting it all together it just was not adding up. When he had these jittering episodes as well it seemed like he was in pain looking at his facial expression. He WASN'T fussy and hard to calm. So that didn't fit. But he was irritable, just easy to calm, again that could have just been a baby thing. A lot of times they aren't fans of being messed with.

So anyway, this is how he was all day. I kept mentioning my concerns over and over and it was blown off. I didn't think the baby was emergent necessarily but I felt something was going on and it just really stuck me that maybe it was withdrawals from something. Mom denied anything on admission so they didn't order a MecStat which seems like 7/10 of the babies get. But this baby wasn't flagged. So towards the end of the shift their was a shift change and I got a nurse that was new to the unit, she was not a new nurse, well not new grad I guess some might consider her still "new" but she was a nurse for 3 years on Medical. So she noted the VS and said the reflex's were just normal baby moro reflex. She had never worked with babys though until now. She had 6 day shifts and 6 night shifts and tonight was her second night alone on the unit. So towards the end of the night I think she could sense my concern and I just looked her in the eyes and said, "I know I am a student. I know we can be overly observant sometimes, I get it, but I know babies and my gut is telling me something is not OK with this baby, something is going on. I can't pin it exactly but seems like withdrawls." Well I guess with her being new, she wanted to be safe, she told me that she would keep an eye on him tonight and maybe call Doc in the morning, but that she would check his on him more frequently. I think she could see I wasn't satisfied, but I thanked her and said ok. It was time for me to go to post conference and I told my CI about the baby and my concerns as well. She is nurse manager on the floor and has worked in that area for a long time, she told me she would be right back and she brought in a withdrawl score card. Told me what all did I see and lets add up a score.

I had never seen one of this before but man this kiddo was a classic case, I was going down the list and it was like CHECK, CHECK, CHECK. So why we were going over this and having our post conference my CI assures me that she will make sure baby is checked out further. We go to leave and my co nurse calls out to me. So I go see her and she says "I just wanted to let you know, I went and talked to the Charge nurse and asked her to further assess baby since I am new and since you were so concerned. She just got done and agrees that baby is showing signs of withdrawal and we are going to be starting the withdrawal inventory, I knew you were worried so I wanted to let you know and also let you know to always go with your gut and never give up on your patient even when it seems like others aren't listening."

So anyway, I just wanted to get that out, it's so important for us to learn how to advocate for our patient, especially when they can't advocate for themselves and always trust your instincts, if they are wrong, no harm is done and it's better to be safe and have the Pt. be ok then to not trust yourself and have something bad happen. Most of the times they are right from what I am told and know.

What better place to come and share too then with fellow students.

Sorry for it being so long and I hope it all makes sense, it's late it's been a long day and I tend to make a lot of mistakes under those circumstances but it's all fresh and it's the best time to get it out LOL.

[Angels_wearScrubs]

that's fantastic that you have that "sixth sense", even though you are "just a student"! I am a second semester student, and it's BEYOND frustrating when you think something is wrong, and no one is listening. I'm glad you have people around you (even if it's just a few) who listen to your concerns!

My school goes through the summer. I am done with second semester in two weeks, but I start summer semester in three and a half weeks. We have OB and peds over 10 weeks... I'm scared!! haha I have no kids, very few of my friends have kids, and I have never seen anyone give birth :chair:

Congrats on following your gut, and I'll be sure to keep your story in mind over the summer. Hope that little baby makes it out ok :redbeathe

[Nurse SMS, MSN, RN]

Hey, really good job on that one! I hope you left with joy in your heart that day knowing you helped this little life.

[~Mi Vida Loca~RN, ASN, RN]

that's fantastic that you have that "sixth sense", even though you are "just a student"! I am a second semester student, and it's BEYOND frustrating when you think something is wrong, and no one is listening. I'm glad you have people around you (even if it's just a few) who listen to your concerns!

My school goes through the summer. I am done with second semester in two weeks, but I start summer semester in three and a half weeks. We have OB and peds over 10 weeks... I'm scared!! haha I have no kids, very few of my friends have kids, and I have never seen anyone give birth :chair:

Congrats on following your gut, and I'll be sure to keep your story in mind over the summer. Hope that little baby makes it out ok :redbeathe

Thank you! We just did our Peds and OB in 8 weeks, it was rough, they split the semester in half so the first half we had Med/Surge and the second half was Peds and OB. I finished clinicals last night. Peds final on Monday, Maternity test and lecture Tuesday. Then Maternity final the next Tuesday and our NLN testing that following monday and I am DONE. I am glad I was put on the first 2 rotations of clinicals and not the last 2 weeks. I have 4 more days of actual school!!!

The couldn't do the MecStat on the baby because he didn't have anymore mechonium poops but they did decide he is either in withdrawals or was wrong due dates and he is preemie. My CI who is also the Nurse Manager on that floor also said that they have set up home health visits to monitor baby as well. It felt great that someone finally listened.

Last night was an interesting night. Was in with an induction and mom was getting an Epidural and dad passed out, nurse caught him said she wasn't letting him fall because she wasn't doing all that paper work HAHA. It was not an easy task trying to hurry and clear off the chair and carry it over everything to get it over to her side. He had his laptop and stuff on it and the Epidural cart was between me and her because I was on the side of the anesthesiologist and this whole time the tiny nurse is holding this guy up and he is completely out.

[~Mi Vida Loca~RN, ASN, RN]

Hey, really good job on that one! I hope you left with joy in your heart that day knowing you helped this little life.

It did, but it was also sad. It was the littlest baby I have taken care of and I just wanted to take him home. Mom didn't seem like she would care anyway. She was completely ambivalent to him I think their was a lot of psychosocial issues present.

[knittingmonster]

I am glad you followed through with your instincts.

What is this trick that your instructor taught you to get baby HR'?

[~Mi Vida Loca~RN, ASN, RN]

I am glad you followed through with your instincts.

What is this trick that your instructor taught you to get baby HR'?

Every 50 raise a finger and start back with one, then add up your 50's and your final round. Makes it so much easier to keep track when you are counting beats over 120.

[knittingmonster]

Thanks for the tip. Now I need to go find a baby to practice it on before ob and peds in the fall!

[~Mi Vida Loca~RN, ASN, RN]

Find a few LOL the younger the faster the HR You can also find the sounds online to practice with speed.